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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 313623424
Report Date: 01/06/2022
Date Signed: 01/06/2022 11:50:52 AM

Document Has Been Signed on 01/06/2022 11:50 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:LI, MIAOMIAOFACILITY NUMBER:
313623424
ADMINISTRATOR:LI, MIAOMIAOFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(707) 508-5160
CITY:GRANITE BAYSTATE: CAZIP CODE:
95746
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:MiaoMiao LiTIME COMPLETED:
12:00 PM
NARRATIVE
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On January 6th, 2022, Licensing Program Analyst (LPA) Jeremey McClain met with Licensee MiaoMiao Li for an unannounced required annual inspection.

Upon arrival, Licensee’s assistant Chunhui Wang was supervising five children. Licensee arrived approximately 10 minutes after. The complete census during the inspection was six children, which included two infants. Licensee stated there aren’t new residents in the home. All adult residents have criminal record clearances.

LPA toured areas of the home accessible to the children. The off-limit areas of the home were inaccessible.

LPA observed the following posted: a license, a Parents' Rights Poster and an Emergency Disaster Plan. LPA observed that licensee has does not have current completion of AB1207 Mandated Reporter training. LPA provided Licensee with website: http://childcare.mandatedreporterca.com/ and reminded the licensee that the training must be completed once every two years.

LPA reviewed children's records for completeness, as well as the client roster. LPA observed records of immunizations for MMR, Pertussis, and influenza/ influenza declination for the licensee, but not her assistant.
During the interior and exterior inspection:
LPA observed that hazardous items (detergents, cleaning compounds, medication, sharp utensils, and other items that could pose a danger to children in care) are properly stored out of children's reach.
LPA observed a fireplace that was properly screened.
LPA observed a working telephone in the home.
Licensee stated that there are no weapons in the home.
LPA observed a fire extinguisher as well as functional carbon monoxide and smoke detectors. LPA reminded licensee that fire drills documented should be conducted once every six months and documents.
REPORT CONTINUED ON THE FOLLOWING PAGE.
SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME: LI, MIAOMIAO
FACILITY NUMBER: 313623424
VISIT DATE: 01/06/2022
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Equipment and furnishings in areas where children are active appeared to be safe and in working order.
Licensee has a pool that is fenced with a self-latching gate that is at least five feet high, that opens away from the pool.

This facility does not currently provide Incidental Medical Services- IMS. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm.

To improve the quality and value of the new inspection process, a survey will be sent to the email address provided. Please complete the survey and share your inspection experience. If you have any questions regarding the process or tools, please send them by email to inspectionprocess@dss.ca.gov. For additional information regarding the inspection and its tools and methods, please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/process.

Deficiencies were observed during today’s inspection and are cited on the following page of this report.

SUPERVISORS NAME: Keven Peters
LICENSING EVALUATOR NAME: Jeremey McClain
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2022
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Document Has Been Signed on 01/06/2022 11:50 AM - It Cannot Be Edited


Created By: Jeremey McClain On 01/06/2022 at 11:29 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833

FACILITY NAME: LI, MIAOMIAO
FACILITY NUMBER: 313623424

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1596.8662(b)(1)
Administration of Child Day Care Licensing
(1) On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child day care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated reporter training every two years following the date on which he or she completed the initial mandated reporter training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, LPA observed that the licensee has not renewed the training after her previous one expired on 11/2021. If not corrected, this poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2022
Plan of Correction
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LPA provided licensee with the website inside of the 809 report. Licensee will renew the training and send proof of completion to LPA by the POC due date of 02/07/2022.
Type B
Section Cited
HSC
1597.622(c)
Administration of Child Day Care Licensing
(c) The family day care home shall maintain documentation of the required immunizations or exemptions from immunization, as set forth in this section, in the person's personnel record that is maintained by the family day care home.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee was not able to provide record of Staff #1's required immunizations, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2022
Plan of Correction
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Staff #1 will provide proof immunizations(MMR, TDAP, Influenza, TB) to licensee. Licensee will maintain proof of Staff #1's proof of immunization at the home, and send proof to LPA by the POC due date 02/07/2022.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Keven Peters
LICENSING EVALUATOR NAME:Jeremey McClain
LICENSING EVALUATOR SIGNATURE:
DATE: 01/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/06/2022


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